National Committee for Quality Assurance (NCQA) & HEDIS 4/3/2017

If you are a Health Plan in the US you are most likely aware of the National Committee for Quality Assurance (NCQA) and its role. The NCQA Accreditation is the most comprehensive evaluation of Health Plans in the nation, and is the only assessment program whose accreditation scores are based on actual results achieved on a set of clinical measures and consumer experience measures. NCQA-Accredited plans have a competitive advantage over non-accredited plans that includes respected, third-party validation of their quality and a detailed roadmap for continuous improvement that drives value.

NCQA Health Plan Accreditation includes two major components on which a plan’s performance is scored: standards, an evaluation of the plan’s structure and processes to maintain and improve quality in the core areas; and Healthcare Effectiveness Data and Information Set (HEDIS®), an evaluation of the plan’s performance on process and outcomes in clinical care and member experience of care.

DataHub is starting to engage with Health Plans to help them improve their HEDIS score and provide better outcomes for the members and ultimately that is the goal.

What are some of the challenges facing Health Plans & HEDIS measurements as it relates to data & analytics?

DataHub has put together best practices to help Health Plans become more proactive & agile on analytics and how they can derive at better outcomes for their members.

To achieve the alignment essential to improving HEDIS ratings, we suggest looking at the groups within your Health Plan that could have the most influence if they were to collaborate. This graphic shows key areas to consider.

Here are a few ways to encourage cross-functional collaboration. For example:

1. From an organizational structure standpoint, identify a roadmap that enables departments to engage members and providers intelligently so you can improve rates by maximizing efficiency. People, programs and technologies are likely all spread thin, so aligned engagement is critical to using resources effectively.

2. Examine the resources that are dedicated to quality — the programs that use data beyond HEDIS submissions. How can cross-functional sharing create mutually beneficial results?

3. Consider your provider network: Is risk-sharing part of the design? This can help increase provider participation.

4. Identify providers with low HEDIS scores and align those with coding inconsistencies. This process will help determine which engagement strategies will work best.

5. Bring the functional areas together through data and reporting. The more integrated your functional areas are, the more all can work toward a common goal.

DataHub would welcome the chance to be discuss strategies and direction as it relates to your HEDIS goals. You can reach us at This email address is being protected from spambots. You need JavaScript enabled to view it..